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But I only made this the rule, there are exceptions to it. There are those who will not let their friends be placed in an asylum, under any consideration ; and there are those, who, if placed in an asylum would receive more harm than good ; when you meet with those cases you will have to treat them in their own dwellings. You will then have to convert a part of the house into an asylum, in so far that you must separate your patient from the immediate family, and provide a good keeper and nurse-tender for them who will strictly carry out your instructions. Five different members of the society have had such cases, where I have been called in consultation, and each and every case have recovered their sanity. So you see it is necessary that you should give some of your attention to the treatment of insanity. I do not see why many cases of mental disorders should not be treated at home, and by any medical practitioner who chooses to treat them, particularly cases of puerperal mania, when removal is sometimes attended with great danger to the patient: but I also think, as I have already said, that the necessary physical as well as the moral force should be used, and the treatment that has proved efficacious in asylums, should be applied to similar cases when treated outside. But as a rule, for the reasons already given, I believe an asylum the best place for the treatment of the insane.
There is one thing, however, you can all do, and which you are bound to do, and that is to always remember that prevention is better than cure; and it is for you to use your best efforts to prevent the increase of insanity by opposing with all your persuasive powers, brain forcing in both the young and middle-aged ; by, when you are consulted on the marriage question, honestly telling those who seek for your advice the danger to be apprehended from persons marrying where there is hereditary taint, by teaching men to live sober, chaste and cheerful lives, observing moderation in all things. Above all you must impress upon society that if we wish to diminish insanity and its twin sister crime, we must do so by diminishing poverty and ignorance. It is not yet established, and I am not prepared to say that it ever will be, that all criminals are insane, yet it is very hard to believe that a man can be very sane who forces society to deprive him of his freedom and place him under restraint.
FRACTURE OF THE PATELLA,
PLEURO-PNEUMONIA DURING CONVALESCENCE:
THROMBOSIS OF PULMONARY ARTERY.
BY THOS. G. RODGER, M.D., POINT ST. CHARLES.
J. B., æt. 45 years, a tall, powerfully-built man, met with a fracture of the patella on the morning of the 20th of December, 1877. Nothing particular (transpired during the first month,) more than is commonly met with during attendance upon such cases, and at the end of that period I removed the splint appliances, and I put the knee-joint in a preparation of plasterof-paris, which, by-the-way, the patient spoke of as being very comfortable. At this time union felt pretty firm, and everything in connection with the fracture seemed doing well.
On Monday, the 4th of February, the seventh week from the date of the accident, I was requested to visit the patient, and found that he had not been feeling well for two or three days, yet not sufficiently ill, as he thought, to seek for advice.
I found his face very much flushed, and he appeared somewhat excited and anxious ; tongue coated, bowels constipated. He drew my attention to the large quantity of urine he had passed during the last twelve hours : filling six pickle bottles, sp. gr., normal, of good color, and no albumen. Pulse 120; temperature, 100°, respirations 40.
Has had no chill, no cough; there is no dulness on percussion behind, and only a few crepitant rales heard during deep inspiration, audible only for a time, then disappearing. Treatment R. Liq. ammon, acet. with tinct. digitalis, and poultices of linseed meal and mustard to the chest.
February 5th.-Face still very much flushed, and breathing hurried. Pulse 110; temperature, 99 2-5°. Bowels acted freely during the night. Complaining of pain in the right side on deep inspiration. Faint pleuritic friction-murmur to be heard at point referred to as seat of pain. Slept very little all night, and required to occupy a half-sitting position for comfort, owing to dyspnoea.
6th.—Patient somewhat easier this morning, and passed a better night, countenance also bearing a less anxious expression.
Pleuritic friction still distinct, though faint, but entire absence of cough, a few crepitant rales to be heard posteriorly at base of the lungs, but no dullness. Advised change of posture to-day; in fact have been urging so for many days back, but patient is afraid to move on account of fracture.
7th.— Temperature 100 3-5o. Pulse 120, and he is restless and nervous. Complains of suffocation, or tightness about the chest. Heart and lungs both examined, the former perfectly healthy, the latter not presenting anything more than already mentioned. Respiration hurried, dyspnoea considerable. Will not allow himself to be much disturbed, and has taken very little nourishment, but considerable alcoholic stimulants.
8th.—Much the same as yesterday, only that he has taken more nourishment.—Has been sitting np for a short time on sofa.
9th.—Still no change. Slept well during early part of last night.
10th.—Restless all night. Pulse, 120; temperature 101o. Again complaining of feeling of suffocation.
I asked Dr. Drake to see the case with me this morning and after examining the patient thoroughly, he agreed that possibly the symptoms were due to long confinement to bed, and again it was urged that the sitting posture be adopted.
Cardiac and alcoholic stimulants to be still continued.
10 p.m._Pain in the side, very severe, administered gr. morph. mur. (hypodermically). Dyspnoea not so severe.
11th.-Ilas had a pretty good night, and feels comfortable. Face still still slightly flushed. Pulse 112. Temperature 100°. Pulse, 40. He has been lying on his right side since early morning, and says that he thinks that he breathes more freely in that position.
12th.-Did not sleep all night, very restless. Bowels moved freely early this morning. Temperature 102 3-5° Pulse 128; respirations, 50. Called Dr. Drake in consultation again today. Found slightly diminished resonance on percussion at the lower angle of both scapulæ, but on auscultation the respiratory murmur is quite indefinite in character. No heart murmur can be detected, but the action of the organ is somewhat tumultuous in character. No cough whatever. Had a slight attack of syncopy this afternoon on sitting up to take a little nourishment; and again made reference to the feeling of suffocation, before referred to.
14th.— I was summoned very early this morning, the patient having been very restless all night, complaining of severe pain at the lower end of the sternum, and immediately below the right nipple. Again administered i gr. morphia hypodermically. Pulse, 120; temperature 100°; respirations 45. 10. p.m. Still making complaint of pain at lower end of sternum, and below the right nipple. Speaks of the pain as being constant, attended with a feeling of tightness.
Ordered hot poultices of linseed and mustard, and left word with attendants that if the pain continued or became worse to send me word.
At midnight patient expressed himself as feeling much easier, and was about to have a poultice applied, when he was again seized with a syncopal attack, and before I reached the house, which was in a few minutes, expired.
POST-MORTEM, BY DR. OSLER. Patella is fractured in transverse direction, segments united by fibrous tissue. Some of synovial folds are injected, in spots hæmorrhagic.
Heart of average size. Clots in right auricle, and in the ventricle there is a small
, tolerably firm, buff-coloured clot closely interwoven with the chordæ tendineæ. On slitting up the pulmonary artery, a firm thrombus occupies the trunk, adherent to the lower wall, and it extends into the right and left branches, not entirely filling their lumina, but closely united where in contact with the intima. On further dissection the thrombi can be followed into many of the branches of the 3rd and 4th degree. They are reddish brown in colour, firm, not laminated, but of leathery consistence throughout.
Nothing of special note in left chambers.
In right pleura half a pint of turbid fluid ; upper lobes crepitant and of good colour, and on section there are one or two spots of red hepatization. Pleura over the part inflamed.
No infarctions. Left lower lobe also dark, and but slightly crepitant, but no hepatization. Nothing of note in other organs. NO. LXXXII.
CASE OF INTUSSUSCEPTION,
WITH SEPARATION AND PASSAGE BY STOOL OF 17 INCHES
By L. TREMAIN, M.D., EDIN., OF CHARLOTTETOWN, P.E.I.
Read before the Medico-Chirurgical Society of Montreal.
We are indebted to Dr. James McLeod of Charlottetown, Prince Edward Island, for the following very interesting case from notes taken at the time by Dr. Tremain. The specimen was shown at the meeting of the Medico-Chirurgical Society of Montreal, held on the 2nd May, 1879.--ED.
On the 12th March, 1879, I was called to see Albert Best, aged 14 years, who had been ill for some nine days, suffering from constipation and pain in the abdomen. He had been under the care of another medical man, but in consequence of his absence I was requested to see the patient. I found considerable pain, some tenderness and tympanitic distention of the abdomen. There was no fever, the surface of the body was cool, and his pulse not over 80. I was informed that he had had no passage from his bowels since the 2nd March. There was a look of much anxiety, he had been vomiting freely during the day, and I was shown a chamber utensil, which was half full of vomited matter, thin and feculent. This was the third time he had vomited a quantity of matter similar in quality.
Before I saw him, I was informed that he had had several enemata, and some purgative medicine, but no result had followed except the discharge of some hardened masses from the lower bowel. Hot fomentations had been used freely and constantly. I ordered immediately large enemata of warm water, and repeated them frequently throughout the treatment, at the same time I ordered six powders of calomel and opium, which were repeated every four hours. I saw him frequently throughout the three following days, during which time the treatment consisted in the administration of opium, without the calomel, hot fomentations over the abdomen, and enemata. On the 16th his bowels were freely moved, which gave much relief, and he took nourishment